Abdominal Radiology

, Volume 42, Issue 1, pp 124–140 | Cite as

Beyond gastric adenocarcinoma: Multimodality assessment of common and uncommon gastric neoplasms

  • Danielle M. RichmanEmail author
  • Sree Harsha Tirumani
  • Jason L. Hornick
  • Charles S. Fuchs
  • Stephanie Howard
  • Katherine Krajewski
  • Nikhil Ramaiya
  • Michael Rosenthal
Pictorial Essay


Despite advances in molecular biology, imaging, and treatment, gastric neoplasms remain a significant cause of morbidity and mortality; gastric adenocarcinoma is the fifth most common malignancy and third most common cause of death worldwide (Brenner et al., Methods Mol Biol 472:467–477, 2009; Howson et al. Epidemiol Rev 8:1–27, 1986; Roder, Gastric Cancer 5(Suppl 1):5–11, 2002; Ferlay et al., GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. International Agency for Research on Cancer, 2013). Because of both the frequency at which malignant gastric tumors occur as well as the worldwide impact, gastric neoplasms remain important lesions to identify and characterize on all imaging modalities. Despite the varied histologies and behaviors of these neoplasms, many have similar imaging features. Nonetheless, the treatment, management, and prognosis of gastric neoplasms vary by pathology, so it is essential for the radiologist to make every effort to differentiate between these lesions and raise the less common entities as differential diagnostic considerations when appropriate.


Gastric cancer Benign gastric neoplasms Malignant gastric neoplasms Metastasis 



Author C.S.F. is supported by GI SPORE Grant # P50CA127003.

Compliance with Ethical Standards

Conflict of Interest

None of the other authors have declared any conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Brenner H, Rothenbacher D, Arndt V (2009) Epidemiology of stomach cancer. Methods Mol Biol 472:467–477. doi: 10.1007/978-1-60327-492-0_23 CrossRefPubMedGoogle Scholar
  2. 2.
    Howson CP, Hiyama T, Wynder EL (1986) The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev 8:1–27CrossRefPubMedGoogle Scholar
  3. 3.
    Roder DM (2002) The epidemiology of gastric cancer. Gastric Cancer 5(Suppl 1):5–11CrossRefPubMedGoogle Scholar
  4. 4.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin D, Bray F (2013) GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. International Agency for Research on Cancer. Accessed on October 28, 2014
  5. 5.
    Park SH, Han JK, Kim TK, Lee JW, Kim SH, Kim YI, Choi BI, Yeon KM, Han MC (1999) Unusual gastric tumors: radiologic-pathologic correlation. Radiographics 19(6):1435–1446. doi: 10.1148/radiographics.19.6.g99no051435
  6. 6.
    Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system. Classification of tumours of the digestive system, 4th edn. IARC Press, LyonGoogle Scholar
  7. 7.
    Hamilton SR, Aaltonen LA (eds) (2000) World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive system. IARC Press, LyonGoogle Scholar
  8. 8.
    Washington K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17(12):3077–3079. doi: 10.1245/s10434-010-1362-z CrossRefPubMedGoogle Scholar
  9. 9.
    Yoon H, Lee DH (2014) New approaches to gastric cancer staging: beyond endoscopic ultrasound, computed tomography and positron emission tomography. World J Gastroenterol 20(38):13783–13790. doi: 10.3748/wjg.v20.i38.13783 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bentley-Hibbert S, Schwartz L (2015) Use of Imaging for GI Cancers. J Clin Oncol 33(16):1729–1736. doi: 10.1200/JCO.2014.60.2847 CrossRefPubMedGoogle Scholar
  11. 11.
    Park do Y, Lauwers GY (2008) Gastric polyps: classification and management. Arch Pathol Lab Med 132(4):633–640. doi: 10.1043/1543-2165(2008)132[633:GPCAM]2.0.CO;2
  12. 12.
    Feczko PJ, Halpert RD, Ackerman LV (1985) Gastric polyps: radiological evaluation and clinical significance. Radiology 155(3):581–584. doi: 10.1148/radiology.155.3.4001357 CrossRefPubMedGoogle Scholar
  13. 13.
    Carmack SW, Genta RM, Schuler CM, Saboorian MH (2009) The current spectrum of gastric polyps: a 1-year national study of over 120,000 patients. Am J Gastroenterol 104(6):1524–1532. doi: 10.1038/ajg.2009.139 CrossRefPubMedGoogle Scholar
  14. 14.
    Ba-Ssalamah A, Prokop M, Uffmann M, Pokieser P, Teleky B, Lechner G (2003) Dedicated multidetector CT of the stomach: spectrum of diseases. Radiographics 23(3):625–644. doi: 10.1148/rg.233025127
  15. 15.
    Harned RK, Buck JL, Sobin LH (1995) The hamartomatous polyposis syndromes: clinical and radiologic features. AJR Am J Roentgenol 164(3):565–571. doi: 10.2214/ajr.164.3.7863873 CrossRefPubMedGoogle Scholar
  16. 16.
    Levy AD, Quiles AM, Miettinen M, Sobin LH (2005) Gastrointestinal schwannomas: CT features with clinicopathologic correlation. AJR Am J Roentgenol 184(3):797–802. doi: 10.2214/ajr.184.3.01840797 CrossRefPubMedGoogle Scholar
  17. 17.
    Kang HC, Menias CO, Gaballah AH, Shroff S, Taggart MW, Garg N, Elsayes KM (2013) Beyond the GIST: mesenchymal tumors of the stomach. Radiographics 33(6):1673–1690. doi: 10.1148/rg.336135507
  18. 18.
    Hong HS, Ha HK, Won HJ, et al. (2008) Gastric schwannomas: radiological features with endoscopic and pathological correlation. Clin Radiol 63(5):536–542. doi: 10.1016/j.crad.2007.05.026 CrossRefPubMedGoogle Scholar
  19. 19.
    Hur BY, Kim SH, Choi JY, et al. (2011) Gastroduodenal glomus tumors: differentiation from other subepithelial lesions based on dynamic contrast-enhanced CT findings. AJR Am J Roentgenol 197(6):1351–1359. doi: 10.2214/AJR.10.6360 CrossRefPubMedGoogle Scholar
  20. 20.
    Miettinen M, Paal E, Lasota J, Sobin LH (2002) Gastrointestinal glomus tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 32 cases. Am J Surg Pathol 26(3):301–311CrossRefPubMedGoogle Scholar
  21. 21.
    Taylor AJ, Stewart ET, Dodds WJ (1990) Gastrointestinal lipomas: a radiologic and pathologic review. AJR Am J Roentgenol 155(6):1205–1210. doi: 10.2214/ajr.155.6.2122666 CrossRefPubMedGoogle Scholar
  22. 22.
    Lee MH, Choi D, Park MJ, Lee MW (2012) Gastric cancer: imaging and staging with MDCT based on the 7th AJCC guidelines. Abdom Imaging 37(4):531–540. doi: 10.1007/s00261-011-9780-3 CrossRefPubMedGoogle Scholar
  23. 23.
    Levy AD, Abbott RM, Rohrmann CAJr, Frazier AA, Kende A (2001) Gastrointestinal hemangiomas: imaging findings with pathologic correlation in pediatric and adult patients. AJR Am J Roentgenol 177(5):1073–1081. doi: 10.2214/ajr.177.5.1771073 CrossRefPubMedGoogle Scholar
  24. 24.
    Park SH, Han JK, Choi BI, et al. (2000) Heterotopic pancreas of the stomach: CT findings correlated with pathologic findings in six patients. Abdom Imaging 25(2):119–123CrossRefPubMedGoogle Scholar
  25. 25.
    Cho JS, Shin KS, Kwon ST, et al. (2000) Heterotopic pancreas in the stomach: CT findings. Radiology 217(1):139–144. doi: 10.1148/radiology.217.1.r00oc09139 CrossRefPubMedGoogle Scholar
  26. 26.
    Kim JY, Lee JM, Kim KW, et al. (2009) Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma. Radiology 252(1):92–100. doi: 10.1148/radiol.2521081441 CrossRefPubMedGoogle Scholar
  27. 27.
    Fishman EK, Urban BA, Hruban RH (1996) CT of the stomach: spectrum of disease. Radiographics 16(5):1035–1054. doi: 10.1148/radiographics.16.5.8888389
  28. 28.
    Motohara T, Semelka RC (2002) MRI in staging of gastric cancer. Abdom Imaging 27(4):376–383. doi: 10.1107/s00261-001-0118-4 CrossRefPubMedGoogle Scholar
  29. 29.
    Binstock AJ, Johnson CD, Stephens DH, Lloyd RV, Fletcher JG (2001) Carcinoid tumors of the stomach: a clinical and radiographic study. AJR Am J Roentgenol 176(4):947–951. doi: 10.2214/ajr.176.4.1760947 CrossRefPubMedGoogle Scholar
  30. 30.
    Sarlomo-Rikala M, Kovatich AJ, Barusevicius A, Miettinen M (1998) CD117: a sensitive marker for gastrointestinal stromal tumors that is more specific than CD34. Modern Pathol 11(8):728–734Google Scholar
  31. 31.
    Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M (2003) Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 23(2):283–304, 456; quiz 532. doi: 10.1148/rg.232025146
  32. 32.
    Burkill GJ, Badran M, Al-Muderis O, et al. (2003) Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 226(2):527–532. doi: 10.1148/radiol.2262011880 CrossRefPubMedGoogle Scholar
  33. 33.
    Agaimy A, Wunsch PH (2009) Lymph node metastasis in gastrointestinal stromal tumours (GIST) occurs preferentially in young patients < or = 40 years: an overview based on our case material and the literature. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie 394(2):375–381. doi: 10.1007/s00423-008-0449-5 CrossRefGoogle Scholar
  34. 34.
    Miettinen M, Wang ZF, Sarlomo-Rikala M, et al. (2011) Succinate dehydrogenase-deficient GISTs: a clinicopathologic, immunohistochemical, and molecular genetic study of 66 gastric GISTs with predilection to young age. Am J Surg Pathol 35(11):1712–1721. doi: 10.1097/PAS.0b013e3182260752 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Doyle LA, Hornick JL (2014) Gastrointestinal stromal tumours: from KIT to succinate dehydrogenase. Histopathology 64(1):53–67. doi: 10.1111/his.12302 CrossRefPubMedGoogle Scholar
  36. 36.
    Choi H, Charnsangavej C, de Castro Faria S, et al. (2004) CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. AJR Am J Roentgenol 183(6):1619–1628. doi: 10.2214/ajr.183.6.01831619 CrossRefPubMedGoogle Scholar
  37. 37.
    Holdsworth CH, Badawi RD, Manola JB, et al. (2007) CT and PET: early prognostic indicators of response to imatinib mesylate in patients with gastrointestinal stromal tumor. AJR Am J Roentgenol 189(6):W324–330. doi: 10.2214/AJR.07.2496 CrossRefPubMedGoogle Scholar
  38. 38.
    Taxy JB, Battifora H (1988) Angiosarcoma of the gastrointestinal tract. A report of three cases. Cancer 62(1):210–216CrossRefPubMedGoogle Scholar
  39. 39.
    Restrepo CS, Martinez S, Lemos JA, Carrillo JA, Lemos DF, Ojeda P, Koshy P (2006) Imaging manifestations of Kaposi sarcoma. Radiographics 26(4):1169–1185. doi: 10.1148/rg.264055129
  40. 40.
    Ghai S, Pattison J, Ghai S, O’Malley ME, Khalili K, Stephens M (2007) Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics 27(5):1371–1388. doi: 10.1148/rg.275065151
  41. 41.
    Ferrucci PF, Zucca E (2007) Primary gastric lymphoma pathogenesis and treatment: what has changed over the past 10 years? Br J Haematol 136(4):521–538. doi: 10.1111/j.1365-2141.2006.06444.x CrossRefPubMedGoogle Scholar
  42. 42.
    Campoli PM, Ejima FH, Cardoso DM, et al. (2006) Metastatic cancer to the stomach. Gastric Cancer 9(1):19–25. doi: 10.1007/s10120-005-0352-5 CrossRefPubMedGoogle Scholar
  43. 43.
    Mesa H, Rawal A, Rezcallah A, et al. (2009) “Burned out” testicular seminoma presenting as a primary gastric malignancy. Int J Clin Oncol 14(1):74–77. doi: 10.1007/s10147-008-0804-0 CrossRefPubMedGoogle Scholar
  44. 44.
    Yamamoto H, Deshmukh N, Gourevitch D, et al. (2007) Upper gastrointestinal hemorrhage as a rare extragonadal presentation of seminoma of testis. Int J Urol 14(3):261–263. doi: 10.1111/j.1442-2042.2007.01685.x CrossRefPubMedGoogle Scholar
  45. 45.
    Coskun M, Agildere AM, Boyvat F, Tarhan C, Niron EA (1998) Primary choriocarcinoma of the stomach and pancreas: CT findings. Eur Radiol 8(8):1425–1428CrossRefPubMedGoogle Scholar
  46. 46.
    Guilford P, Hopkins J, Harraway J, et al. (1998) E-cadherin germline mutations in familial gastric cancer. Nature 392(6674):402–405. doi: 10.1038/32918 CrossRefPubMedGoogle Scholar
  47. 47.
    Rogers WM, Dobo E, Norton JA, et al. (2008) Risk-reducing total gastrectomy for germline mutations in E-cadherin (CDH1): pathologic findings with clinical implications. Am J Surg Pathol 32(6):799–809. doi: 10.1097/PAS.0b013e31815e7f1a CrossRefPubMedGoogle Scholar
  48. 48.
    National Comprehensive Cancer Network (NCCN) Gastric Cancer (Version 1.2014). 2014Google Scholar
  49. 49.
    Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ (2011) Juvenile polyposis syndrome. World J Gastroenterol WJG 17(44):4839–4844. doi: 10.3748/wjg.v17.i44.4839 CrossRefPubMedGoogle Scholar
  50. 50.
    van Lier MG, Wagner A, Mathus-Vliegen EM, Kuipers EJ, Steyerberg EW, van Leerdam ME (2010) High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations. Am J Gastroenterol 105(6):1258–1264; author reply 1265. doi: 10.1038/ajg.2009.725
  51. 51.
    Capelle LG, Van Grieken NC, Lingsma HF, et al. (2010) Risk and epidemiological time trends of gastric cancer in Lynch syndrome carriers in the Netherlands. Gastroenterology 138(2):487–492. doi: 10.1053/j.gastro.2009.10.051 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Danielle M. Richman
    • 1
    Email author
  • Sree Harsha Tirumani
    • 1
    • 2
  • Jason L. Hornick
    • 3
  • Charles S. Fuchs
    • 4
  • Stephanie Howard
    • 2
  • Katherine Krajewski
    • 2
  • Nikhil Ramaiya
    • 2
  • Michael Rosenthal
    • 2
  1. 1.Department of RadiologyBrigham and Women’s HospitalBostonUSA
  2. 2.Department of ImagingDana-Farber Cancer InstituteBostonUSA
  3. 3.Department of PathologyBrigham and Women’s HospitalBostonUSA
  4. 4.Gastrointestinal Cancer CenterDana-Farber Cancer InstituteBostonUSA

Personalised recommendations